title: Collagen plug sealing of iatrogenic fetal membrane defects after fetoscopic surgery for congenital diaphragmatic hernia.
abstract: OBJECTIVE
  To investigate the efficacy of collagen plugs at reducing the risk of preterm premature rupture of membranes (PPROM) after fetoscopic surgery for congenital diaphragmatic hernia (CDH).
  
  
  METHODS
  This was a single-center cohort study on all consecutive cases undergoing fetoscopic endoluminal tracheal occlusion (FETO) for severe or moderate CDH, between April 2002 and May 2011 (n = 141). Cases either received a collagen plug for sealing the fetal membrane defect after FETO or did not, depending on the operating surgeon. The principal outcome measure was the time from fetal surgery to PPROM, further referred to as 'latency'. A multivariable Cox regression model was used to investigate the association between collagen plug and latency while adjusting for risk factors for PPROM.
  
  
  RESULTS
  Of the 141 cases, 54 (38%) received a collagen plug and 87 (62%) did not. Sixty cases experienced PPROM, 26 among cases with and 34 among cases without a plug (48 vs 39%). The hazard ratio of plug use was 1.29 (95% CI, 0.76-2.19), which does not exclude a potentially increased risk for PPROM when a collagen plug is used. For cases with a plug, 24% had PPROM before balloon removal and 24% had PPROM after elective balloon removal. For cases without a plug, these rates were 30 and 9%, respectively. Perinatal outcomes were similar in both groups.
  
  
  CONCLUSIONS
  No evidence was found that collagen plugs reduce the risk of PPROM after FETO for CDH.
authors.affiliation: KU Leuven, Centre for Surgical Technologies, Leuven, Belgium.
authors.forename: A C
authors.initials: AC
authors.lastname: Engels
authors.forename: B
authors.initials: B
authors.lastname: Van Calster
authors.forename: J
authors.initials: J
authors.lastname: Richter
authors.forename: P
authors.initials: P
authors.lastname: DeKoninck
authors.forename: L
authors.initials: L
authors.lastname: Lewi
authors.forename: L
authors.initials: L
authors.lastname: De Catte
authors.forename: R
authors.initials: R
authors.lastname: Devlieger
authors.forename: J A
authors.initials: JA
authors.lastname: Deprest
mesh_terms: D000328:Adult; D003094:Collagen / Q000627:therapeutic use*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000209:etiology / Q000628:therapy*; D005332:Fetoscopy / Q000009:adverse effects*; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007049:Iatrogenic Disease; D007231:Infant, Newborn; D011247:Pregnancy; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
chemical_list: D003094:Collagen
keywords: CDH; FETO; PPROM; collagen plug; fetal membranes; fetoscopic intervention